Listening to his Heart

December 27, 2004
I’ve been a member of a group that meets for prayer, fellowship and study for over a year now. This fall we were studying a book on healing and I was working at a rural Veteran´s Administration primary care clinic. I was telling the group about performing evaluations for the Agent Orange registry, and how so many of the vets are wounded – mentally, physically and spiritually. After the discussion, Lynn really had a burden to pray for me and my ministry, and who was I to say no? I couldn´t recall anyone else in 18 years of practice ever asking to come alongside me in my ministry of healing as a doctor.

I had shared a couple of the most striking stories with the group, but I was not surprised that after they laid hands on me the patient care was incredibly ordinary, mundane, and unexceptionable. I finished up my main stint at the VA and came back home for Thanksgiving. I was scheduled to work a few extra days in December to help with the vacation coverage. The first week back I was able to clean up a large backlog of charts AND preview all the computer records for the first day of the second week.

So as I drove up the second week I was feeling pretty good that I wouldn’t be missing anything important due to a backlog of charting. As I drove I was remembering the group’s laying-on of hands and smiling to myself about how nothing unusual had seemed to happen afterward. I arrived at the clinic just as they brought the first patient back. After I had seen a couple of guys, my nurse came by to inform me that the next guy was having trouble breathing. (I knew what that meant – an at-least-60-minute visit in a 20-minute slot and therefore a significant derailment of the schedule. I rolled my eyes but I wasn’t really upset; I’d already had to admit 2 or 3 supposedly stable “routine follow-up” patients directly to the hospital from the clinic during the earlier stint and I knew it was always a possibility.) So, even before I saw him, experience was telling me that I’d be admitting him as well because he likely was having a heart attack.

I walked over to the treatment room to start evaluating the patient. “Fred” was lying on the gurney with his eyes closed. He was in his late 70’s, and I knew from my previous chart review that he, like the majority of the patients there, had a personal medical history that put him at high risk for heart attacks – diabetes, elevated cholesterol, age, etc. He was accompanied by a daughter-in-law who appeared to be in her early thirties and a granddaughter who couldn’t have been much over five. I started taking the history from Fred. He’d come back to his son´s house the night before after taking refuge with other relatives when the power went out during the ice storm. The daughter in law had noticed he seemed short of breath. The day of the visit he barely made it in from the parking lot up the stairs, and finally gave out in the hall before he got to the reception desk. And by the way, he was having pain in his neck.

Fred kept his eyes closed while I talked to him, and he kept saying “I’m sorry” and “Don’t be mad at me.” Whenever he said that, his daughter-in-law would reassure him that no one was mad at him. This must have happened at least 25 times during about 30 minutes. I began to get curious about what was behind it.

After I got the history, I put on my stethoscope to listen to Fred’s heart. Just as I touched his chest he began to sob loudly. Alarmed, I pulled back, thinking perhaps I had startled him by touching him without warning. No, that wasn’t it, but he couldn’t tell me what it was. “I just feel like bawling lately! Help me, help me, Jesus,” he said. I asked him if he would like me to pray with him. “Yes,” he said, and so I took his hand and prayed that Jesus would bring him peace and healing.

I went ahead and finished the physical exam, then was moving back and forth between charting and writing in the computer and asking additional questions of Fred and his daughter-in-law. Fred continued to say “I’m sorry, don’t be mad, help me Jesus” at frequent intervals, as well as to tear up and contort his face with emotion.

I asked his daughter-in-law if he’d always done that. “I’m sorry” was frequent, she said, but the crying was something completely new. She continued to reassure him when he said “I’m sorry,” but I started using some reflective listening each time he said it. “You’re sorry?” “You’re worried that someone will be mad?” His responses when I checked things out in that way were only marginally more communicative – nothing that gave me any clue about what the crying and all was about, but I kept reflecting back everything he said.

I finished my charting and orders and checked back with Fred about the pain in his neck, which I thought was angina because a lot of times diabetics don’t get actual chest pain with a heart attack. Six out of ten, he said. I asked the nurse to get a nitroglycerin tablet and I stood by the gurney to wait for her to bring it.

Fred teared up again and I had a sudden thought. (Three months at the VA had sensitized me to the prevalence of post-traumatic stress disorder in World War II vets.) I looked over to the daughter-in-law. “Where did he serve?” I asked. Just at that moment, he began sobbing and pouring out this story:

He had been in Okinawa, and the Japanese troops were trapped by the Allied forces. Rather than be killed by the Allies, they committed hare kiri (suicide). Fred felt responsible for their deaths and was now sobbing out his grief and guilt for the first time in over 50 years. (His daughter-in-law said he had never spoken of it before.)

I reminded him that the Bible says “if we confess our sins, he is faithful and just to forgive us our sins.” I led him in a prayer of confession and then asked him if he could forgive himself (he was having a hard time with this) for the sake of showing his granddaughter the way.

At this point another nurse came in preparatory to transferring him to the inpatient ward. She saw what was going on and came right over to help. “It’s all been covered by the Blood – it’s all taken care of," she told him. We continued to pray and talk to him for a minute or two.

Finally the first nurse returned with the nitroglycerine tablet. “How’s your pain now?” I asked. “Two,” he said, appearing more relaxed than he had previously. He took the nitro and 5 minutes later the pain was gone.

I looked over at his daughter-in-law and she was dissolved in tears. The first nurse was hugging and comforting her. The granddaughter was standing stiff and staring straight ahead. I went over and asked the little girl if she was worried. She didn’t speak or look at me. “You know how you feel better after you cry? Mom and Grandpa feel better just the same way.”

The transport team came and took Fred out on the gurney. The daughter-in-law said to me, “He’s never talked to us about any of that. How did you do that?”

“Well,” I said, “I used active listening to hear what was in his heart. You’ve probably noticed that when you tell him no one is mad at him, it doesn’t really stop him saying it?”

“Yes, that’s true.”

“When people keep saying things like that, there’s something behind it. I got curious and started reflecting back what I was hearing so he would know I was really listening. It’s not that complicated, but it’s not something we get taught in school, and it’s especially hard with family members. I can show you how to do it, though, if you want.”

“Oh, yes!”

“Well, there are three parts. First, you use a tentative opening, because you’re checking to see if you heard correctly what the person is saying. You say something like, ‘so, are you saying’ or ‘am I hearing you say…”

I got a paper towel and a pen and wrote down
1. tentative opening
2. thought content
3. feeling content.

“The second part, thought content, means “what the person is thinking.” For example, ‘someone will be mad’ would be an example of thought content. Then the feeling content is the person’s emotions about that. Sometimes they don’t say them out loud and you have to guess, like ‘you’re worried that someone will be mad at you.’ When you use all three parts, the person knows that you’re really listening and he feels safe to tell you more.”

I handed her the paper towel and said with a smile, “It works really well with husbands and children. I’m a little worried that your daughter may have been upset by all this. You might want to use this to talk to her.”

She got up to go. “Thanks so much,” she said. “You’re welcome, and God bless you,” I replied.

I left the treatment room asked my nurse about the rest of my patients. “You had two more scheduled,” she said. “One called to cancel and the other is a no-show.” It was 11:30 am, and I had finished up exactly on time. God had answered my prayer for Fred to experience peace and healing and I was privileged to be His instrument in fulfillment of the prayers of my small group.